Are you a referring veterinarian?

Welcome to the Dentistry and Oral Surgery Service of the Ryan Veterinary Hospital of the University of Pennsylvania. Our service has a rich history, and our faculty and staff are world leaders in veterinary
dentistry and oral surgery.

What We Offer

The Dentistry and Oral Surgery Service at the Ryan Veterinary Hospital offers the best care for dental and oral surgical patients. The vast majority of procedures are performed under general anesthesia, and all patients receive a comprehensive physical examination including diagnostic tests as necessary prior to anesthesia.

How We Work

The clinical service can be divided into three areas:

Scheduled appointments

Emergency cases

Consultations within the hospital

Scheduled appointments for new patients and reexaminations are usually on Monday and Wednesday mornings. For patients admitted to the hospital, treatment under anesthesia is performed on Tuesdays and Thursdays. For appointments, call 215-746-8387.

Emergency cases admitted through our Emergency Service receive primary attention and will undergo immediate treatment as feasible. Contact Emergency Service at 215-746-8911.

Consultations within the hospital are performed at the request of fellow clinicians. The Dentistry and Oral Surgery Service staff will respond to all requests as soon as the clinical/surgical schedule allows.

In the nineteenth century, veterinary dentistry and oral surgery was limited to the care of teeth of horses.

Only relatively recently were veterinary dentistry and oral surgery recognized as a specialty in both small and large animals. Penn was the first veterinary school in North America to offer an organized program in veterinary dentistry and oral surgery in the 1970s.

A full-time veterinary dentistry and oral surgery residency training program—the first in the world—was established at Penn in 1989. This program has trained more board-certified veterinary dentists and oral surgeons than any other program.

Application Process:

The Dentistry and Oral Surgery Service at the Ryan Veterinary Hospital is an American Veterinary Dental College–approved residency site. One resident position is available each year. The residency program is three years, full time.

The residents' schedule is structured so that all requirements for a successful AVDC credentials application can be completed and submitted by the resident at the end of the second year. This allows the third year of the residency to include time for preparation for the AVDC examination (usually held in March or April) and time for completion of research or clinical investigation project(s), plus clinical time for a Chief Resident service.

The aim of the three-year program is to produce well-rounded AVDC-certified veterinary dentists and oral surgeons who have participated in and published results of a research project. A residency certificate will not be provided if the resident does not complete the full three years of the program.

The following continuing-education opportunities in dentistry and oral surgery are provided by members of the Dentistry and Oral Surgery Service or offered by other qualified instructors:

Observatory rotation

Laboratory courses

Preparation for the AVDC or EVDC entry examination

Observatory Rotation

This program was established for visiting veterinary technicians and veterinarians who are interested in continuing clinical education in dentistry and oral surgery. Visitors will be observers of clinical and surgical cases but cannot have primary case responsibility. This service is provided on mutually convenient dates and on a space-available basis. The applicant is to provide an agenda of items and define specific goals that are to be met during his/her stay at the Ryan Veterinary Hospital (e.g., visitation time, extent of Diplomate involvement, certain procedures to be observed, credentials requirements to be met, etc.). The costs vary depending on the specific requirements. The Dentistry and Oral Surgery Service weekly schedule is as follows:

Laboratory Courses

The Dentistry and Oral Surgery Service offers various laboratory courses to veterinary professionals. The four- to eight-hour classes consist of one or more didactic presentations and hands-on practice. The classes are limited to four to six participants and are offered several times per year. Please contact Bonnie Miller at 215-898-3351 (or bmiller@vet.upenn.edu) for further information. The following courses are offered:

Oral examination, dental cleaning and basic periodontal therapy

Dental terminology, oral/dental anatomy and tooth numbering systems are discussed. Methods of performing a thorough oral examination are introduced, including extraoral and intraoral structures, teeth and periodontal tissues. Equipment and techniques used to scale and polish teeth are demonstrated. Home oral hygiene methods, including correct tooth brushing and appropriate diets, toys and treats are discussed. Instrument sharpening is demonstrated, and basic techniques of gingival curettage and root planing are practiced.

Dental radiology and radiographic interpretation

Radiation safety/protection and dental radiographic equipment (machine and films) are reviewed. Patient positioning, radiographic exposure techniques (parallel, bisecting angle), film processing (developing and fixing) and digital image enhancement are demonstrated and practiced using standard and digital radiography. Interpretation of various radiographic presentations of oral and dental disease is discussed.

Local anesthesia and tooth extraction

Nerve blocks used to provide local anesthesia during dental surgical procedures are demonstrated and practiced. Indications, contraindications, and mechanics of tooth extraction are discussed. Closed and open techniques used to extract single and multi-rooted teeth in dogs and cats and closure of extraction sites are introduced and practiced, along with demonstration of dental surgical instruments and power equipment. Complications of tooth extraction and their management are discussed.

Preparation for the AVDC or EVDC entry examination

Veterinarians interested in preparation for the AVDC or EVDC entry examination (such as training of procedures for the practical part) may contact Dr. Alexander Reiter (215-573-6539; reiter@vet.upenn.edu) for further information.

Detailed examination of extraoral and intraoral structures and thorough dental and periodontal charting are performed to record abnormalities and allow for appropriate treatment planning. Dental records are legal documents and help determine arrest or progression of previously present pathology. Dental radiography is essential for diagnosis and treatment of dental and periodontal conditions. Full-mouth dental radiographs are usually obtained of all cats and any new patients. Radiographs of the head (skull) are utilized when dental films or digital sensors do not provide enough surface area to visualize all areas of interest.

Computed tomography (CT) imaging is a useful tool for the diagnosis of disease and treatment planning for various conditions of the head, including lesions of the nasal cavity and sinuses; disorders of the temporomandibular joint; fractures of the skull, and oral and maxillofacial tumors. It is of great value for exploration of a large volume of soft and hard tissue in a relatively short examination time. This is particularly important when a rapid diagnosis is needed for patients with head trauma or uncertain head pathology and those that are less than optimal anesthesia candidates. CT is very helpful in detecting lesions of hard tissues (bone and teeth) which is imperative when defining tumor margins and planning radical surgical excision.

Professional dental and periodontal cleaning refers to removal of plaque and calculus (tartar) and elimination of diseased periodontal tissues. This is accomplished with hand instruments (scalers and curettes) and power instruments (various sonic and ultrasonic scalers). Gingival and subgingival curettage are utilized in conjunction with closed root planing to remove the inflamed and infected soft tissue lining of the periodontal pocket. Once all tooth surfaces are cleaned and gingival tissues have been debrided, the teeth are polished with a fine polishing paste and a rubber cup. Perioceutic treatment involves insertion of low-dose antimicrobial gel into cleaned periodontal pockets after root planing and curettage to enhance healing and connective tissue reattachment.

The goals of periodontal surgery include elimination of plaque-retentive areas, reduction of periodontal inflammation, and regeneration of periodontal tissues. The choice of periodontal surgery depends on the type and severity of periodontal disease. Flaps are reflected to allow for tissue debridement, osseous surgery, and placements of osteopromotive materials and then repositioned at varying locations. Sliding flaps, gingival grafting and guided tissue regeneration are procedures designed for creation of physiologic periodontal morphology. Apical positioning flaps are used for crown-lengthening procedures of teeth fractured close to or below the gum line to allow for placement of prosthodontic crowns in working dogs. Gingivectomy and gingivoplasty are procedures to eliminate pseudopockets in patients with gingival enlargement.

Tooth extraction is a surgical procedure. The most common indications for tooth extraction in dogs are periodontal disease and tooth fracture, and in cats tooth resorption and stomatitis. If the disease process is too advanced for the teeth to be saved, extraction is necessary. Financial and other considerations may lead the client to request extraction. There are two techniques, closed and open extraction. Closed extraction is performed without incising the gum tissue. Open extraction requires creation of a periodontal flap and removal of alveolar bone in order to loosen the tooth from its attachments to the jaws. "Full-mouth" extractions are sometimes performed for treatment of severe oral inflammatory conditions such as stomatitis in cats.

Trauma is usually the cause of fractured canine and carnassial teeth in the dog. Tooth resorption may result in crown fractures in cats, with root fragments remaining in the jaws. Vital pulp therapy is primarily utilized for ‘recent’ tooth fractures or after intentional surgical crown reduction to preserve pulp vitality and increase the strength of the tooth by allowing continued dentin formation. Pulp exposure allows bacteria to enter the tooth, resulting in pulpal inflammation and necrosis, which ultimately leads to periapical disease and abscess formation. Standard root canal therapy is then needed to prevent loss of the tooth. Surgical root canal therapy is occasionally required and involves removal of the tip (apex) of the root. Luxated and avulsed teeth require repositioning, stabilization, and endodontic therapy due to the likely loss of blood supply to the pulp.

The goal is to restore a tooth and its function as close as practical to its natural state before the occurrence of disease or trauma. Indications for restorative dentistry include fractured teeth, bonding for enamel hypoplasia and other defects, and management of dental caries and tooth resorption. Newer restorative materials such as composites, glass ionomers and combination products (compomers) have largely replaced amalgam. Extra retention of restorative materials to the tooth can be achieved by the use of pins and posts. The ultimate restorative, however, are ¾ or full-jacket metal crowns which are primarily utilized to restore and protect fractured or weakened teeth of dogs that put their dentition at risk of trauma (e.g., police dogs, military dogs, prison dogs, etc.).

Orthodontics deals with the diagnosis and treatment of dental and skeletal malocclusion. The goal is to provide the patient with a pain-free and functional bite. Neutering should be done to rule out the possibility of transferring genetic components of malocclusion to offspring. Interceptive orthodontics is defined as extraction of deciduous or permanent teeth that cause malocclusion. Passive orthodontic movement is achieved with a direct inclined plane which is commonly utilized for treatment of lingually displaced lower canine teeth (base-narrow or instanding mandibular canine teeth). Buttons and elastic chains are typically utilized to actively move rostrally displaced upper canine teeth (lance teeth, spear teeth). Rather than performing extraction or orthodontic movement, the crown of a maloccluding tooth that causes trauma to adjacent structures may be reduced in length. This requires sterile instrumentation for the vital pulp therapy after surgical crown reduction.

Jaw fractures and oral and maxillofacial soft tissue injury may be due to automobile trauma, falls, kicks, hits, gunshots, and fights with other animals. Pathologic jaw fractures frequently occur secondary to severe periodontal disease. Following stabilization of life-threatening injuries and control of blood loss, soft tissue injuries are cleaned, rinsed and sutured closed. Several techniques are available for successful jaw fracture repair. They include non-invasive and invasive techniques. Non-invasive techniques often make use of the teeth as anchor points for stabilization devices and include maxillomandibular fixation, circumferential wiring, and interdental wiring with intraoral splinting. Invasive techniques are sometimes required and include external skeletal fixation, osseus wiring, and bone plating.

Patients with temporomandibular joint problems may have difficulty either to open or to close the mouth. Acute TMJ luxation is treated by manual joint reduction and tape muzzling to prevent recurrence of luxation. Chronic luxation may require surgical removal of the mandibular condyle. Open-mouth jaw locking can occur when the mouth is opened wide and the coronoid process of the mandible locks lateral to the zygomatic arch. This is commonly confused with TMJ luxation but warrants an entirely different treatment. Acute treatment consists of opening the jaw further to release the coronoid process from the lateral aspect of the zygomatic arch and then closing the mouth. Definitive treatment involves partial resection of interfering bones. The latter surgery is also required in typically young patients with TMJ ankylosis (fusion of the bones that form a joint).

The oral cavity is the fourth most common site of malignant neoplasia in dogs and cats (predominately malignant melanoma, squamous cell carcinoma, fibrosarcoma, and osteosarcoma). Obtaining and examining a biopsy specimen allows the clinician to establish a diagnosis, formulate a treatment regimen, and give the owner information regarding prognosis. Describing the clinical extent (staging) of the malignancy is an essential prerequisite of rational treatment and typically involves aspirating enlarged lymph nodes and obtaining thoracic radiographs. The treatment of choice for most oral and maxillofacial tumors (lip, cheek, tongue, tonsil, mandible, maxilla, palate, etc.) is wide surgical excision. Most mandibulectomies, maxillectomies, and other radical surgeries can be performed without significant compromise of quality of life.

There is a wide variety of reconstructive surgery available, including palate defect surgery (see below), commissuroplasty (a forward advancement of the lip commissure to prevent the tongue from hanging out to the side of the mouth after mandibulectomy procedures), lip and cheek reconstruction (with axial pattern skin flaps that are harvested from the head or neck), jaw bone defect management (with osteoconductive, osteoinductive or osteogenetic grafts), etc. Principles of reconstructive surgery in humans are applied.

Congenital defects of the formation of lip and palatal structures may be inherited or result from an insult during fetal development. Palate defects acquired after birth result from severe periodontal disease, trauma, cancer, and surgical and radiation therapy. Cleft lips rarely result in clinical signs beyond mild local rhinitis, and repair may be performed for aesthetic reasons. Cleft hard and soft palate defects are best repaired in animals of three to four months of age. Preoperative management requires nursing care by the owner, which includes tube feeding to avoid aspiration pneumonia. Palate defects acquired after birth are either repaired surgically or—if applicable—by placement of a silicone or acrylic obturator. Brachycephalic patients with respiratory problems may benefit from surgical expansion of nostrils (naroplasty) and shortening of the soft palate.

Swelling is the most common sign of salivary gland disease and is caused by firm swelling of the gland itself (inflammation, infection, necrosis, neoplasia) or by soft accumulation of saliva in an abnormal area (salivary mucocele). The swelling may be on the side of the face, below the lower jaw, under the tongue, in the pharynx, or beneath the orbit causing the eye to bulge outwards. Biopsy of the swollen gland will help determine benign or malignant pathology, requiring medical therapy or surgical resection. Injuries to the salivary glands and their ducts may result in formation of a mucocele. Marsupialization is a procedure that creates a large opening into the mucocele through which saliva can drain into the mouth. However, this treatment has a tendency to fail and is therefore less successful than complete resection of the involved salivary gland(s).

Some autoimmune diseases manifest along the lips or inside the mouth, others affect the muscles necessary for chewing. These and many other conditions of the head can be treated by means of medications. However, a surgical biopsy is often required for an accurate diagnosis. Our veterinary dentists and oral surgeons perform most soft tissue and bone biopsies related to the mouth, throat, face and masticatory apparatus. They also perform laser surgery for ablation of large oral ulcers as seen in cats and dogs with stomatitis.

This discipline deals with a large variety of special species, including rabbits, guinea pigs, chinchillas, ferrets, reptiles and birds. Patients with beak, dental and oral problems are admitted by our colleagues in Special Species Medicine and Surgery, who will provide the initial care before the dentist and oral surgeon becomes involved. We also perform dental and oral surgical procedures for the Philadelphia Zoo and other exotic animal collections.

The clinical team for Dentistry and Oral Surgery at Penn Vet comprises faculty clinicians, residents, as well as technicians and hygienists.

Dr. Alexander Reiter is an Associate Professor of Dentistry and Oral Surgery and Head of the Dentistry and Oral Surgery Service. He graduated from the University of Veterinary Medicine in Vienna, Austria, in 1996 and spent 1.5 years in companion animal practice in Phoenix, AZ, prior to commencing residency training in dentistry and oral surgery at the University of Pennsylvania School of Veterinary Medicine. Following a three-year lectureship and completion of a postgraduate thesis study on “Tooth Resorption in Domestic Cats”, he joined the standing faculty of Penn’s veterinary school in 2003. Dr. Reiter is a Diplomate of the American Veterinary Dental College and the European Veterinary Dental College. He is the recipient of the 2004 European Veterinary Dental College/European Veterinary Dental Society Award and the 2006 American Veterinary Dental Society/Hill’s Award given for outstanding clinical, teaching and research contributions in veterinary dentistry and oral surgery. Dr. Reiter has been active in American and European specialty organizations and is a frequent lecturer nationally and internationally. His clinical and research interests include comparative aspects of tooth resorption in animals and humans, periodontal surgery, oral and maxillofacial trauma and oncology, palate surgery, facial soft tissue and bone reconstruction, microsurgery (free vascular tissue transfer), systemic impact of periodontal disease and oral manifestation of systemic disease.

Bonnie Miller is a Registered Dental Hygienist (RDH). She earned her Certificate of Proficiency in Dental Hygiene from the University of Pennsylvania School of Dentistry in Philadelphia in 1972 and received her Bachelor of Science in Dental Hygiene from Thomas Jefferson University in Philadelphia in 1992. Bonnie is a member of the American Dental Hygienists Association (ADHA) and the American Veterinary Dental Society (AVDS) and began her career working in human periodontal practices before dedicating her expertise solely to veterinary patients. With 19 years experience in her field, she is responsible for the organization and efficient operation of the Dentistry and Oral Surgery Service. Bonnie provides periodontal therapy to veterinary patients and participates in the service’s clinical research projects. Her role as a dental educator involves teaching the fundamentals of dentistry to veterinary students and organizing dental continuing education courses for practicing veterinarians and technicians (VetDent CE Associates). Bonnie is also a guest lecturer at Philadelphia’s Harcum College veterinary technician program and an advisor for the Academy of Veterinary Dental Technicians (AVDT). She has extensive local, state and national lecturing experience and has authored and co-authored numerous journal articles and book chapters. Bonnie serves as an independent consultant to the veterinary dental industry and performs dental product research for companies wishing to promote oral health via their products. She was recognized by the AVDS in 1996 for her extraordinary contributions to the field of veterinary dentistry and oral surgery.

Jeanette Hernandez, CVT, RDH

Jeanette Hernandez is a Certified Veterinary Technician (CVT) and a Registered Dental Hygienist (RDH). She graduated from Philadelphia’s Manor College with two associate degrees of science, the veterinary technician degree in 2003 and the dental hygiene degree in 2005. Her main goal in accomplishing a dual major was to become specialized in veterinary dentistry and extend this expertise to professionals within the veterinary community. Jeanette has been a member of Penn’s Dentistry and Oral Surgery Service since 2005. She is involved in teaching basic dentistry in the form of rounds and wet labs to fourth-year students during their clinical rotation and participates in admission, care, diagnosis and treatment of veterinary patients and conduction of clinical research. She is currently working towards becoming a Veterinary Technician Specialist (VTS) in Dentistry. Jeanette is a frequent lecturer at local, state and national continuing education conferences and also an instructor on basic dental care to veterinary technician students at Manor College. She also works part-time as dental hygienist in private family dental practice.

The Emergency Service can be contacted 24 hours a day at 215-746-8911. Our Dentistry and Oral Surgery Service clinicians have traditionally not only taken care of patients with dental problems, we are also responsible for primary care of patients with oral and maxillofacial pathology due to infection, cancer or trauma. Certain emergencies affecting the teeth, mouth and face require immediate veterinary medical attention and include (but are not limited to):

Very recent tooth fractures (if there is interest in saving the tooth, animal should be put on antibiotics until referral to the veterinary dentist or oral surgeon).Sharp or blunt head trauma injuries, including lip and tongue lacerations, oral bleeding, gunshot injuries.

Tooth luxations and avulsions (true dental emergencies; put animal on antibiotics and place avulsed tooth in milk until referral to the veterinary dentist or oral surgeon).

Mandibular and maxillary swellings associated with oral and maxillofacial tumors.

Swellings around the nose, mouth, jaws, face and neck associated with inflammation/infection.

Scheduled appointments for new patients and reexaminations are usually on Monday and Wednesday mornings. For patients admitted to the hospital, treatment under anesthesia is performed on Tuesdays and Thursdays. For appointments, call 215-746-8387.

If clients wish to be seen sooner than the next available appointment, they should ask to be transferred to our service phone to make special arrangements.

Emergency cases admitted through our Emergency Service receive primary attention and will undergo immediate treatment as feasible. Contact Emergency Service at 215-746-8911.

Daily Tooth Brushing

An effective home oral hygiene program consists of daily tooth brushing, provision of appropriate diets, and use of various oral health care products (e.g., chlorhexidine-based rinses/gels, chew toys, dental treats, etc.). Periodontal disease is the most common disease occurring in dogs and cats and is defined as plaque-induced pathology of any part of the tissues that hold the tooth in the mouth - the gingiva, periodontal ligament, alveolar bone, and cementum. Plaque is a soft biofilm which contains bacteria and toxins and accumulates on the surface of teeth within hours after a dental cleaning. When accumulation of plaque is prevented by effective oral hygiene, periodontal disease does not develop. When oral hygiene is less than optimal, plaque can mineralize within 2-3 days to form calculus that resists being readily wiped off. Therefore, tooth brushing should be performed once daily to remove plaque from our pets’ teeth. All you need is a soft-bristled and appropriately-sized toothbrush, some patience, and 1-minute of your daily time. Do not use human toothpaste, as it contains foaming agents that can upset your pet’s stomach and fluorides which, when swallowed in sufficient concentrations, may pose a health hazard. You may find the following brushing instructions to be very helpful.

Diets with Benefit to Oral Health

Certain veterinary diets may be advantageous for maintenance of oral health. Many manufacturers have considered the relationship of diets to oral health of pets. So-called 'dental diets' were designed to either mechanically or chemically reduce plaque and/or calculus (tartar) accumulation. Some products provide a combination of both actions. The mechanical action is derived from a larger than usual, hard kibble that fractures into few large pieces as it is penetrated by the tooth, rather than crumbling into many tiny pieces. The large pieces are penetrated again, and thus the more crunching that is performed, the more abrasive action results and the bacteria-laden plaque is being disturbed. Some kibble also has layers of different textures that contribute to plaque disruption. Diets that help to clean teeth by chemical action are coated with various chemicals that have been shown to reduce the accumulation of plaque or calculus. Polyphosphates are used in some of these diets. The Veterinary Oral Health Council (VOHC) provides a list of products that have successfully met pre-set criteria for effectiveness in controlling plaque and tartar deposition in dogs and cats.

Chew Toys and Dental Treats

Chew toys and dental treats can be an important part of any pet dental health program. However, they represent only part of the overall maintenance of oral health.

Toys and treats are used in combination with daily tooth brushing, oral health care products, appropriate diets, yearly dental check-ups, and professional dental cleaning and periodontal therapy as necessary.

There are many different chew toys and dental treats commercially available for our pets. They should not be too hard, as very hard materials can fracture teeth. Inappropriate toys and treats include plastic bones made of hard nylon, meat bones (cooked and uncooked), and cow hooves.

Rocks and large ice cubes can also fracture teeth and should be avoided.

Tennis balls are a popular toy for many dogs; however, they are very abrasive to teeth because they collect tiny particles of dirt and sand and will wear down the teeth and occasionally cause pulp exposure.

Acceptable toys include soft stuffed animals, flexible rubber bones, soft plastic balls, and ropes. Please note that the toy should be appropriate for the size of the animal, and caution should be exerted when pets are left unobserved when playing with toys.

Need for Anesthesia

In order to perform a thorough periodontal examination, dental radiography, scaling and polishing, gingival curettage and root planing, the pet must be under general anesthesia. Anesthetic gas and oxygen are delivered through an endotracheal tube, thus ensuring pain-free procedures and also protecting the airways from aspirating fluids or debris. Owners of pets naturally are concerned when anesthesia is required for their pet. However, anesthesia-free dentistry performed by untrained individuals is inappropriate for several reasons, including:

Significant safety concerns for the patient and operator.

Insufficient cleaning of inaccessible tooth surfaces.

No debridement of periodontal pockets.

Oral discomfort and serious pain.

Accidental aspiration of debris that can result in pneumonia and death.

Furthermore, it is illegal for anybody but licensed veterinarians or supervised and trained veterinary technicians to practice veterinary medicine.

Frequency of Professional Dental Cleaning

The frequency of the need for professional dental cleanings is dependent upon several factors. If thorough home oral hygiene is being provided on a daily basis, the bacterial accumulations should be minimal, and scaling and polishing procedures can be performed less frequently.

Specific breeds, such as Yorkshire terriers and miniature schnauzers are more prone to developing periodontal disease; therefore, a professional dental cleaning should be performed more frequently.

Your pet should have an annual oral examination performed by a professional to document the presence of abnormal conditions such as periodontal disease, fractured or decayed teeth, tumors, ulcers, etc.

Professional dental cleanings require your pet to be anesthetized in order for the skilled and trained operator to remove debris from below the margins of the gums (subgingivally). Since periodontal disease causes the destruction of the supporting structures of the teeth (gingiva, periodontal ligament, and bone), cleaning the crowns of an awake dog without addressing what lies beneath only provides a cosmetic benefit. This superficial procedure does not address the disease in deeper tissues or less accessible sites.

In general, the condition (color, texture, shape) of the gingival tissues will dictate the need for placing your pet under general anesthesia to have professional dental scaling, polishing and intra-oral radiographs.

Periodontal Disease

This is an inflammatory response to infection of the periodontal tissues by plaque bacteria. Gingivitis is the reversible form of periodontal disease, affecting gingiva only. As inflammation continues, the gingiva detaches from the tooth, creating a periodontal pocket. Bacterial toxins and enzymes from inflammatory cells cause further destruction of periodontal tissues.

Periodontitis is the more severe form of periodontal disease, resulting in attachment loss, gingival recession, and loss of alveolar bone. In multi-rooted teeth, the furcation between two roots becomes exposed. The loss of alveolar bone is usually irreversible, and with increasing bone loss the tooth becomes mobile and ultimately falls out.

Halitosis (bad breath) often accompanies periodontal disease. The systemic effects of periodontal disease are well documented in humans and include heart disease and stroke, diabetes, respiratory disease, and increased risk of premature delivery and low birth weight infants.

Studies about the impact of periodontal disease on systemic health in dogs and cats are currently conducted by Penn faculty. A thorough oral examination includes probing of the gingival sulcus with a periodontal probe and radiography of the teeth with dental radiographic film and a dental x-ray unit.

The goal of periodontal therapy is elimination of plaque and surgical reduction of periodontal pockets. Systemic antibiotic therapy should never be used as the sole treatment regimen.

Professional dental cleaning (often called a dental prophylaxis or prophy) refers to scaling, smoothing the root surfaces (root planing), and polishing of all crown and subgingival tooth surfaces.

Professional periodontal therapy refers to elimination of diseased periodontal tissues by means of periodontal surgery. If a tooth has lost 50% or more of its attachment to the jaw bone, then extraction of this tooth is to be considered. Some severely affected teeth can be successfully retained in the mouth by a combination of scaling, root planing, periodontal surgery, and conscientiously applied home oral hygiene.

Fractured and Worn Teeth

If dental trauma has exposed the pulp cavity, bacteria can enter the pulp through the fractured or worn crown. If left untreated, the pulp becomes inflamed and necrotic, and a periapical abscess may develop.

Endodontic therapy is then needed to prevent the possibility of tooth loss. Alternatively, the tooth can also be extracted.

Dental radiography, special instruments and materials, knowledge of various techniques, and sufficient operator skills are required for performing endodontic and restorative procedures.

Fractures that extend under gums deep into the root must be treated with periodontal surgery prior to endodontic therapy. The two basic endodontic treatment options are:

• Vital pulp therapy

• Standard root canal therapy

Teeth of young animals have a fairly wide pulp cavity, while in old animals the pulp cavity is usually very narrow. The narrower the pulp cavity, the thicker are the dentinal walls, and thus the stronger is the tooth.

Vital pulp therapy is primarily utilized for very recent tooth fractures (less than 2 days of duration) in young animals (less than 2 years of age). Sterile instruments must be used, and systemic antibiotics are recommended perioperatively.

The infected portion of the pulp in the crown is removed, a pulp dressing is placed, and the tooth is restored. Dental radiographs are obtained in 4-6 months to confirm pulp vitality.

If the animal is older or the pulp is exposed for longer periods of time, standard root canal therapy is performed. It consists of accessing the pulp cavity and debriding, shaping, disinfecting and filling the root canal with an inert material, followed by access restoration.

Dental radiography is of utmost importance during all steps. The goal of treatment is the removal of diseased or necrotic pulp tissue and providing a hermetic seal around the root(s). Antibiotic therapy is generally not required.

Luxated and Avulsed Teeth

Tooth displacement injuries frequently occur after automobile accidents, falls from great heights, fighting with other animals, or when a tooth gets caught in a fence.

A tooth can be luxated to the side, into the alveolus (nasal cavity in the case of a maxillary canine tooth), or to the outside. When a tooth is completely out of its alveolar socket, then we call it an avulsed tooth. The teeth most commonly avulsed in dogs are the incisor and canine teeth.

Luxated and avulsed teeth are dental emergencies and require immediate repositioning, stabilization, and endodontic therapy due to the likely loss of blood supply to the pulp. Success of replantation is influenced by the speed with which the tooth is replanted.

The avulsed tooth should be placed in a transport medium (such as fresh milk which keeps periodontal ligament cells vital for up to 6 hours) until arrival of the patient and tooth at our hospital.

Antibiotic therapy (amoxicillin/clavulanic acid, clindamycin or doxycycline) must be started as soon as possible. The tooth is then replanted, and a splint is applied.

In 1-2 weeks, the splint is removed, and endodontic therapy is performed with a calcium hydroxide paste fill. In another 2 weeks, standard root canal therapy is performed. Resorption of the replanted tooth is a common complication, particularly if the avulsed tooth has been allowed to dry on air for longer than 20 minutes.

Oral Tumors

Oral tumors may be benign or malignant (having the potential to spread to distant sites). Even those that are benign may be locally invasive and may result in oral pain, bleeding, drooling, or difficulty eating. Unfortunately, dogs and cats often show no obvious clinical signs until the oral tumor is already very large. It is important to have a thorough oral examination done regularly in an attempt to diagnose these tumors in the early stages. An incisional biopsy of the tumor may be done prior to treatment to determine tumor type and treatment options. Treatment may include one or more of the following:

Surgery: Removal of a portion of the lower (mandibulectomy) or upper jaw (maxillectomy) are generally very well tolerated, and in many cases result in pets with good function and cosmetic appearance.

Radiotherapy: Alone or in combination with surgery, depending on the tumor type, location, and the ability to remove the tumor surgically.

Chemotherapy: Few oral tumors respond to chemotherapy alone, but chemotherapy may be prescribed to minimize spread to distant sites.

We believe patients with rapidly growing oral tumors should receive immediate veterinary medical attention. Oral tumors are best treated before they have a chance to enlarge to the point where they are no longer surgically removable.

The research program is focused on clinical research in dentistry and oral surgery. Our primary goals are to prevent disease and to optimize patient care. This can be accomplished by:
Enhancing knowledge of oral pathology development and,
Expanding diagnosis and treatment options.

Clinical research makes use of existing patient material by maintaining comprehensive medical and dental records, collecting specimens (tissue and fluid samples), and ensuring adequate follow-up. Investigational studies on privately-owned animals are sometimes performed (e.g., on patients with oral cancer when available treatment options have failed or are declined by the owner), require consent by the patient owner, and must be approved by the University of Pennsylvania Institutional Animal Care and Use Committee (IACUC).

Current Research Interests

Periodontal disease

Evaluation of associations between oral disease and kidney health in cats.